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NIH Stroke Scale Update Test Questions with 100% Correct Answers | Updated & Verified how much time to budget to perorm NIH scale - ANS- 7 - 10 mins How many items on the NIH stroke scale? - ANS- 11 NIH Stroke scale is - ANS-an 11-item clinical evaluation instrument widely used in clinical trials and practice to assess neurologic outcome and degree of recovery from stroke. NIH Stroke Scale is used to quantify the effects of acute cerebral ischemia on levels of ... (7 items) - ANS-levels of:
consciousness vision motor function (facial and extremities) cerebellar function sensation language extinction or inattention NIH SS is used to measure patient's status after a stroke and to assess the outcome after - ANS-treatment Should the patient be coached? Should you go back and rethink a particular assessment? - ANS-NO Having what when using NIH scale is important? - ANS-reference materials DO NOT RATE what you think the patient wants to do or what you think they can do, RATE ONLY - ANS-rate only what they actually do
subjective as to whether it is one of which classification? - ANS-mild, mod, severe start to recognise aphasia when you meet them and start talking and you don't get a history of... - ANS-what happened dysarthria is interesting because there are many cultural things about slurred ________? - ANS-speech. Score is associated with prognosis? - ANS-YES Is NIH scale a measure of disability? - ANS-NO. The NIH scale is a measure of impairments. The NIH scale creates a common currency so that everybody understands the patient's level of... - ANS-deficit, by giving a number that communicates to other professionals how sick the patient is What effort should be recorded? Do not do what? - ANS-The patient's first effort. Don't
go back and change scores. IMPORTANT CONVENTIONS IN ADMINISTRATION: Administer scale items in their exact ______
- Avoid ______ing patient
- Accept patient's _______ effort
- Score only what the patient _______
- Be consistent
- Include all _________s into scoring, including those that may be from _________s ______s - ANS--order
- coaching
- first
- does
- Be consistent
- previous strokes ITEM 1a and how to get it - ANS--examiner's overall impression of patient alertness
- ask 2-3 questions about circumstances of admission, stimuate patient by patting or tapping, occasionally pinching NIH Item 1a Scoring: 0
ITEM 1B SCORING
2 - ANS--answers both qs correctly
- answers 1 q correctly OR patients unable to communicate d/t intubation, oral-tracheal trauma, severe dysarthria from any cause, language barrier, or any issue not secondary to aphasia
- answers neither question correctly --> a 3 on 1a must be a 2 on 1b A patient that cannot speak but is otherwise able to communicate can be allowed to convey the answer how? - ANS-writing If the patient answers incorrectly first and then corrects self, how is the answer scored?
- ANS-it is still scored as incorrect What if patient gives DOB as answer to question asking for their age? How is this scored? Is there credit for partial answers that are close like being off a month when answering what month it is?
- ANS-This is scored as a WRONG answer. NO
NIH 1C is what? Make sure to position what in testable position - ANS-Commands Eyes and Hands NIH 1C ask patient to do how many actions and what are they? - ANS-3 commands "close your eyes for me" "now open them" "now make a fist with your hand" NIH 1C - may I repeat the commands? May I encourage? May I pantomime command? May I hold up arm for hand to make fist? - ANS-Yes, you can repeat command ONCE. No, no encouragement or coaching. Yes, you should try and pantomime command so that patient receives verbal and visual input. Yes, can hold up arm for hand command NIH scale 1C scoring: 0 1
NIH scale #
- first test, noting what?
- second test - ANS--look at position of eyes at rest, noting spontaneous eye movements to left or right
- then move finger or other target from side to side and ask patient to track MOVING EYES ONLY, being sure to keep asking patient to follow the target If patient does not accurately follow finger, a stronger test is needed USE what other tests? - ANS-oculocephalic maneuver, eye fixation or tracking of the examiner's face Item 2 - if patient has ocular rotary problems, such as strabismus, but leaves mid-line in attempt to look both left and right, what should the response be considered? - ANS- normal Item 2 Best Gaze Scoring
- partial gaze palsy
- forced deviation 0 1 2 1 2 If there is a conjugate deviation of eyes that can be overcome with voluntary or reflexive activity, score a - ANS- 1 If patient has isolated cranial nerve paralysis such as ocular motor or abducens palsy, score a - ANS- 1 Best Gaze - score a 2 if - ANS-there is forced deviation or total gaze paresis not overcome by the oculocephalic maneuver conjugate lateral deviation not overcome with reflexive movements, score a - ANS- 2 tonic deviation such that eyes cannot be moved, score a - ANS- 2
for item 3, have patient look where and tell them what should both eyes be open? - ANS-patient is to look in examiner's eyes and they are to be told that peripheral vision is being tested and that I may move a finger to the right, a finger to the left, or both - COVER ONE EYE when performing item 3, ask patient to do what - ANS-count fingers in all four quadrants Item 3 - if a patient scored 3 on item 1a, they are tested for 3 using what? and what is it? - ANS-bilateral threat NIH scale 3 scoring:
- ANS- 0 - no visual loss, upper and lower visual fields are normal
- clear cut asymetry, including quadrantanopia or partial hemianopia
- complete hemianopia
- bilateral hemianopia (blindness of any cause including cortical blindness) 0
item 3: if patient has severe monocular visual loss d/t intrinsic eye disease and visual fields in other eye are normal, examiner should score as - ANS-normal if there is unilateral blindness or enucleation, what is scored - ANS-visual fields in the remaining eye arbitrary rule that if they extinguish even if intact to confrontation, visual field item is scored as a... - ANS- 1 NIH item 4 is... - ANS-facial palsy in NIH #4,you ask patient - ANS-"show me your teeth," if no teeth in say "show me your gums"
score for obtunded or comatose patient or one with unilateral-lower motor neuron facial weakness decreased spontaneous and forced facial movements are most prominent at what location? - ANS-the mouth if there is a clear cut asymmetry of the smile, the score is... - ANS-two, all other subtle asymmetries are scored as a one score of 3 re: face is reserved for unusual complete paralysis seen with some strokes of what kind? - ANS-some brain stem strokes NIH scale item 5 is... - ANS-Item 5 - Motor Arm what is proper positioning for item 5 motor arm movement? - ANS-extend arms 90 deg if sitting OR 45 deg if supine item 5 leg test always in what position and how many deg - ANS-leg motor test supine and extended 30 deg
for item 5 motor arm, score a drift if arm does when and when? - ANS-if arm falls before 10 seconds as you count down out loud for motor leg, score a drift if leg does what and when
- ANS-if leg falls before 5 seconds motor items: begin counting when? - ANS- immediately at the release of the limb how should the examiner be counting down? why? - ANS-verbally and with fingers in full view of the patient, so the patient receives verbal and visual input watch for what upon release of the limb? what to consider about this? - ANS-watch for an initial dip after release of the limb, only score abnormal if there is a downward drift after the dip each arm is tested in turn beginning with the... - ANS-non-paretic arm when testing arms, what position for palms? - ANS- down
4 - ANS- 0 - no drift 1 - drift: if arm jerks or drifts down to intermediate position without encountering support, such as a bed, before a full 10 seconds 2 - some effort against gravity but the arm cannot get to or maintain the proper position and drifts down to some support 3 - no effort against gravity and the arm falls 4 - if patient is unable to make voluntary movements to differentiate between 3 and 4 on arm, you have to
- ANS-encourage the patient and wait a second or two to observe movement in the paretic arm Any movement at all including small proximal movements such as shoulder shrug or hip flexion is enough to do what to the arm motor score?
- ANS-lower from 4 to 3 a patient who scores 3 on 1a LOC is scored what on 5? - ANS-they are scored a 4 NIH scale item 6 is... - ANS-motor leg
NIH scale item 6 scoring
- ANS- 0 - no drift and leg holds 30 deg position for 5 seconds 0 1 2 3 4 1 - if there is drift and leg falls before end of 5 sec period but does not hit support such as bed 2 - when there is some effort against gravity but leg falls to support within 5 sec 3- no effort against gravity and leg falls to support immediately but patient makes small movements such as hip flexion or adduction 4- if patient is unable to make voluntary movements what items are the most reproducible of the NIH scale? are they important to ultimate outcome? - ANS- 5 and 6 yes, they are the most imporant
